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If the tubes are still available, perhaps a ABO typing could help From: Clinical biochemistry discussion list [mailto:[log in to unmask]] On Behalf Of Wolfgang Schneider Sent: Monday, November 15, 2010 10:14 AM To: [log in to unmask] Subject: RE CK puzzle There are four results that don't match between the sample from 10:45 and the one rom 23:30 although the CK is the most striking. To me that would indicate that the sample for biochemistry ( serum separator tube ? ) was from a different patient , whereas the blood bank samples ( and other samples e.g. hematology ) were correctly identified . I would investigate the procedure for labelling tubes at your routine test center . Do your phlebotomists label tubes in advance ? *************************************************************** Wolfgang Schneider, PhD, CSPQ, FCACB Chef du service clinique de biochimie Hôpital du Sacré-Coeur de Montréal 5400, boul. Gouin Ouest Montréal, Québec H4J 1C5 Canada Tél.: (514) 338-2222 x 2611 Fax : (514) 338-3171 Courriel: [log in to unmask] *************************************************************** "JONES Stuart (Pathology) (RF4) BHR Hospitals" <[log in to unmask]>@JISCMAIL.AC.UK "JONES Stuart (Pathology) (RF4) BHR Hospitals" <[log in to unmask]>@JISCMAIL.AC.UK Envoyé par : Clinical biochemistry discussion list <[log in to unmask]> 2010-11-12 10:27 Veuillez répondre à "JONES Stuart (Pathology) (RF4) BHR Hospitals" <[log in to unmask]> A [log in to unmask] cc Objet CK puzzle A friday afternoon puzzle for you all: 75 yo man attended phlebotomy 11/11 10:45am for routine GP bloods: (All Olympus AU2700) CK - 5784 (<170) ALT - 28 (<40) AST - 100 (<40) TBIL - 19 (<17) UE/GLU/CRP/BONE/CHOL - NAD Sample slightly haemolysed Phoned to out of hours service as result not generated until 6pm, patient subsequently admitted to A+E 11/11 23:30 apparently well and asymptomatic: CK - 138 ALT - 16 AST - 17 TBIL - 8 TSH - 3.24 TNI <0.006 UE/GLU/CRP/BONE/CHOL - NAD Both CK results checked at least three times on two analysers. Patient details on form and sample all match and, excluding the above, all biochem results comparable + blood group/phenotype identical in both samples. PMO Previously raised CK (774 - 4/3/10, 114 - 29/03/10) unknown cause (not on statin) Hypertensive BPH Meds (only recent change was lisinopril 2.5 to 5mg on 6/11) Lisinopril Tolterodine Finastride Dosulepin I believe half-life of CK is approx 15-18hrs, is it physiologically possible for CK to fall this quickly? Any other ideas? Stuart Jones Senior Clinical Scientist Biochemistry Pathology Queens Hospital Barking, Havering and Redbridge University Hospitals NHS Trust Rom valley way Romford Essex RM7 OAG 01708 435552 Barking, Havering & Redbridge University Hospitals NHS Trust – Most Innovative Trust in London 2009 This communication, together with any files or attachments transmitted with it contains information which is confidential and may be subject to legal privilege and is intended solely for the use by the person(s) or entity to whom it is addressed. If you are not the intended recipient you must not copy, distribute, publish or take any action in reliance on it. If you have received this communication in error, please notify [log in to unmask] and delete it from your computer systems. Barking, Havering & Redbridge University Hospitals NHS Trust reserves the right to monitor all communications for lawful purposes. 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